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Mr. Edward Timpson (Crewe and Nantwich) (Con): May I add my praise and admiration for the dedication, professionalism and sheer hard graft of all those in the emergency services, who do so much to help so many of us? In particular, I should like to praise my local hospital, Leighton hospital, and to thank my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) for mentioning the great work that it does. Its staff often work in difficult, traumatic and treacherous circumstances, and they deserve the highest praise that we can give them.
The Secretary of State mentioned the capacity of our A and E units to cope with the demand, particularly over the Christmas and new year period. He talked about shutdowns, during the 1980s and 1990s, in A and E departments that could not cope with the demand, and said that that was a thing of the past. Sadly, however, Leighton hospital had to close for six hours over Christmas because it could not cope with the demand coming through its doors, despite the long hours and hard work put in by the staff. We have to recognise the fact that that problem is still out there, and work even harder to ensure that we have the capacity to cope with such demand at any time of the year, including the Christmas period.
In this important debate, I particularly want to highlight the often unrecognised, unsung work of our community first responders. We must remember that they are volunteers who give up their own time and money to care for people in our local communities, who rely on them not only to respond to tragic accidents but to save lives. They perform a vital, life-saving service in Crewe and Nantwich, and that is recognised by, and embedded in, the local community. I have had the privilege of meeting a number of community first responders, not only in my own constituency but across Cheshire. It is clear that they are extremely highly regarded, not only by local residents but by the local councils, by the control centre staff with whom they deal directly, and by the paramedics on the ground, who appreciate the great work that they do. Unless we have full paramedic coverage and a blanket of defibrillators across an entire area, community first responders will have a role to play in ensuring that they are available to support their local community wherever their care and professional ability are needed.
Community first responders are a key component in relation to the response times to emergency calls. Unfortunately, the response times in Cheshire have historically been unsatisfactory. Indeed, last year, the North West Ambulance Service fell almost 20 per cent. below its target for reaching calls to life-threatening cases within eight minutes. As many Members will know, the sooner a response can be made, the better chance there is of survival for that patient. Every second is critical when a life is under threat.
Other Members have highlighted the fact that local ambulance trusts are able to hide behind their regional statistics on response times. Those statistics often mask great deficiencies in the local response times throughout the area. We have already heard about one area of the country in which the local ambulance trust has failed to respond to all category A calls with the target eight-minute period. Indeed, that also applies in the Audlem area in my own constituency, where 100 per cent. of the category A calls were not reached within eight minutes.
That serves only to re-emphasise the importance of the role that the community first responders play in our local communities. I am delighted that, after the three meetings that I have had with the chief executive of the North West Ambulance Service, he and the local primary care trustand my hon. Friend the Member for Eddisbury (Mr. O'Brien), who sits on our Front-Bench shadow teamhave managed to put together a working group to look at local response times and to encourage the ambulance service and the community first responders to work together, to ensure that whenever there are professional, qualified community first responders available, they are called on, so that everyone in the local community has the best chance of getting a response as soon as possible.
Mr. Stephen O'Brien (Eddisbury) (Con): My hon. Friend is to be congratulated on the tremendous vigour with which he has fought the campaign to get some sense into the restoration of a good community first responders service, not only in his own constituency, since fighting the by-election there, but in the neighbouring area, which includes my constituency, and the more rural areas of Audlem and Buerton. I hope that he agrees that there would be no need for community first responders if the performance of the North West Ambulance Service were at least up to target, either in the more urban environments in his own constituency, or in the remoter rural parts of mine. The services targets have been missed by a large margin, and, with the restraint put on the community first responders, we now face a major challenge in getting our constituents to Leighton hospital so that their needs can be met. I am grateful to my hon. Friend for his efforts, but I wonder whether he agrees that the community first responders are effectively filling a major gap that has arisen due to the inadequacy of the North West Ambulance Service? The service has repeatedly been challenged on this matter, and we have reached the point at which we demand answers.
Mr. Timpson: I am grateful to my hon. Friend, who has got to the nub of the issue. One of the community first responders in Nantwich has told me directly, I wish I didnt even have to be here. He said that he had to fill in the gaps, as my hon. Friend says, to ensure that there was a proper service that met the needs of the local people of Nantwich. Although he enjoys his job and gets great satisfaction out of it, he would prefer not to have to do it. If there were a 24-hour paramedic service on the doorstep of everyone who lives locally, he would certainly not have to.
A process is taking place that the North West Ambulance Service calls a standardising of the service. It is essentially downgrading the role that community first
responders play in the local community. It is taking away the life-saving drugs that they administer at the scene of an accident or in a case of trauma, and reducing their responses to certain calls such as those involving children. Perhaps most concerning of all, it is taking away their ability to use a blue light as part of their response. The original intention behind community first responders was, to quote a report by the Healthcare Commission on the Staffordshire ambulance service,
to provide a prompt emergency services for communities that ambulances could not reach so quickly, and to improve the outcomes for patients where the speed of the first intervention can be critical, especially those with chest pain or having a cardiac arrest.
The removal of the blue light has disabled community first responders from ensuring that they can get to the scenes of category A and other calls as soon as possible. As a result, the number of calls to community first responders in the Nantwich area has been reduced from about 80 a month to just one or two a week.
Sadly, the removal of those responsibilities of community first responders last May came at a time when a young father in my constituency needed their help. In a tragic incident, the ambulance was unable to reach him within the specified eight-minute period. The community first responder was not called, because of the downgrading of the service, and the young father died. The justification for the standardising of the North West Ambulance Service was the Healthcare Commission report that I have just cited, but of course the role of community first responders is different for each trust. In Nantwich, the responder is someone who not only has many years experience in the role but is qualified at the highest standard to drive with a blue light. It seems bizarre in many respects to take away the opportunity for him to respond as quickly as possible, given that he has both the training and professionalism to do so. He has done so for four years with no incident. Restricting the capabilities of the community first responders potentially puts lives at risk.
The Secretary of State said earlier that he wanted change for the benefit of patients. We certainly want such change, but we have not seen evidence that the changes to the responsibilities of the community first responders are an example of that. The depth of feeling about their role is palpable in my constituency, as I am sure it is in constituencies across the country. The situation has led not only to a petition of more than 10,000 local names being signed and delivered to Downing street but to the first march through the streets of Nantwich for a considerable time. Having spoken to some more expert local historians than I am, I understand that it is the first since the civil war. That is how strong the local feeling is. The community first responders are held in very high regard and provide a valuable service. The sooner a highly qualified community first responder can be on the scene, the greater the chance of a successful outcome.
We have been told that the North West Ambulance Service wants to expand the community first responder service, and indeed it has started to make moves in that direction. However, new CFRs are becoming qualified on the basis of just 18 hours of training, without responding to the category A, B and C calls that, as the hon. Member for Wyre Forest (Dr. Taylor) pointed out, need to be recognised as part of their service. That
seems an unfortunate way in which to treat people who volunteer their services and have the capacity to ensure that the response times are met. They also offer two other benefits.
First, community first responders are great value for moneythey do not ask for anything for their actions; indeed, they plough in their own money to perform the task. Local financingoften given by town councils and other charitiescovers their role. They therefore provide a direct benefit to the NHS and the local community. Secondly, they are not only locally accountable but they have immense local knowledge. An ambulance that comes from many miles away may have directions about how to reach the patient, but the driver may not know the patient, and may not know the road intimately or be able to get there as fast as a community first responder. Local knowledge is therefore vital in providing the service.
It is time for ambulance trusts throughout the country, especially in my area, as well as the Government, to listen to the voice of the public about a service that is vital but currently undervalued. The community first responders have shown that they are willing not only to serve but to give to the best of their ability. It is only right that they are allowed to do that.
Madam Deputy Speaker: I now have to announce the result of a Division deferred from a previous day. On the motion relating to Northern Ireland, the Ayes were 276 and the Noes were 184, so the question was agreed to.
Mike Penning (Hemel Hempstead) (Con): It is a pleasure to respond to the debate on behalf of Her Majestys Opposition on such an important subject, which affects all our constituents and the whole country.
I pay tribute to all staff in the NHS, whether in the emergency or primary care sectors. They do a wonderful job and we should praise them at every opportunity. I also take the opportunity, following my recent visit with other parliamentarians to Afghanistan, to praise NHS staff serving in the Territorial Army, especially in the emergency centres and triage centres in places such as Camp Bastion, which could not survive without the NHS contribution to our armed services. Their work there is simply fantastic.
We are in a sad predicament. At one stage, when I looked at the Government Benches, I thought I was in an Adjournment debate. Only one Labour Back Bencher made a speech on the NHS. Remember 1997 and 24 hours to save the NHS? Yet the Government Benches could not be filled for such an important debate. Only one Labour Back Bencher, who is desperate to save her seat, contributed. If she returns, I shall consider her speech shortly.
Let me consider the Secretary of States opening remarks. I want especially to deal with urgent care. It worried me that the right hon. Gentleman referred to another review, which may happen sometime in future, into urgent care, especially a second emergency number. When looking at my notes, I found it interesting to remember that the Government promised us a framework for urgent care three years ago, in 2006. Six months
later, Lord Warner promised a strategy by the end of the year. In the first half of 2007, the right hon. Member for Doncaster, Central (Ms Winterton) promised that we would have an answer about the secondary number. Again in 2007, Lord Darzi mentioned it in his reports. Now, in early 2009, the Secretary of State mentions it again. We do not need it to be mentioned; we need action.
This morning, Ofcom stated in its parliamentary briefing that it would conduct an immediate reviewI hope that the Secretary of State is aware of todays announcementand that it will look into the numbers that are available as well as 999. I will deal later with some of the comments about whether we need a second number or whether everything can be done through using 999.
Ofcom has specifically said that it would be inappropriate to use 888. Most people understand that, especially those who live in London. Anyone in the area covered by the 7 code who had to dial 8 could end up dialling 888 inappropriately. However, Ofcom has suggested that it would be possible to use not only the 116 116 numbers, with the permission of our European friends, but triple numbers from 102 to 119, including 117. Myriad numbers are available should the Government wish to proceed. Ofcom is on board. We have been calling for the change for two and a half years. It is imperative that the public have a simple way of accessing urgent care, not myriad different services all the way through.
We have heard many contributions today, mostly from the Benches behind me, and it is important that we consider some of them. The Liberal Democrat spokesman, the hon. Member for Romsey (Sandra Gidley), talked about 116 numbers, but she was slightly confused when she said that she did not want the public to go through an operator system. That is not what is proposed. Most of the ambulance trusts operate a system similar to what is proposed already. My concern is duplication. We do not have unlimited cash in the NHS. We cannot have the public confused with different numbers; nor can we have the cost of different services by different agencies.
There was also some confusion when the hon. Lady responded to the interventions that my hon. Friend the Member for West Chelmsford (Mr. Burns) made on her. The ambulance service is a complex system and we need to try to understand how it operates. I ask the hon. Lady to go to one of the ambulance trusts and to sit there while staff are doing a triage call, because it is fascinating. The minute a call comes in, staff are dispatched, based on the location of the call. They would much rather turn back an ambulance or downgrade a call than worry that they were not getting people there.
There is a concern about the eight-minute call, which means that staff need to get someone there within eight minutes 75 per cent. of the time. We understand that. What cannot happen, but what is happeningthis has followed the amalgamation of the ambulance trusts, although I do not think that it was intentionalis that, because the number of responses getting there in time is grouped, if an ambulance trust has an urban and a rural part, which most do, it can have an attendance rate of almost 100 per cent. in time in the urban part, but almost zero in the rural part. I am sure that that is the point that the hon. Lady was trying to make.
I am really disappointed that the right hon. Member for Enfield, North (Joan Ryan) is not in her place. She made a contribution of nearly 15 minutes, in which her position on the future of Chase Farm hospital flip-flopped. In the consultation on Chase Farm she opted for option 1, which is to downgrade the Chase Farm A and E facilities. That was her position then. Her position today is that she is fighting to keep all the facilities at Chase Farm. The right hon. Lady cannot have her cake and eat it. Either she is for her Government, who are willing to close the A and E department at Chase Farm, or she is not. It will be this Government who will close the A and E departments at Chase Farm hospital, at Welwyn Hatfield hospital and, yes, at Hemel Hempstead hospital. That is something that I go on and on about, and I am very proud to do so. The reason why I go on about it so hardit is also why my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) is in his place, unlike the right hon. Member for Enfield, Northis that the community does not want to lose the life-saving facilities that they have now.
The Secretary of State was trying desperately to say that we should take no notice of the experts who say that an urgent care centreor whatever title we want to useis not a replacement for an A and E department. The right hon. Lady went on about the myths propagated in her constituency; and interestingly enough, she came up with a myth herself. She should have looked at the report that the College of Emergency Medicine published just before Christmas. The College of Emergency Medicine issued a list of myths, and the right hon. Lady managed to hit the first one. Myth 1, the College of Emergency Medicine says, is that
60 per cent. of patients attending an A&E department could be seen, to the same clinical standards, at less cost, in other settings
I understand from my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) that the Secretary of State said the same thing. In fact, the College of Emergency MedicineI am sure that the Secretary of State would agree that it is an expertsays:
Between 5 and 10 per cent. of patients attending an Emergency Department...should be treated in primary care.
Another 20 per cent. of patients could be treated in primary care
settings, but that is it. So the absolute maximum percentage of patients attending an A and E who couldnot shouldbe treated is 30 per cent. The myth propagated by the Secretary of State and by the right hon. Lady is that it is 60 per cent. That, frankly, is wrong.
My hon. Friend the Member for West Chelmsford provided a wealth of experiencenot only from his time as a shadow Minister, but as a member of the Health Select Committee before my time on itand showed us just what could be done if we engage with the hospital in the local community. The information that he put forward was absolutely vital. I completely agree with him that many of the problems of emergency
departments are to do with alcohol and alcohol abuse, and I agree with him about the assaults and abuse that NHS hospital staff have to take. The Government could do something about that tomorrowand the Secretary of State should do something about it tomorrow. Why are only one in 1,000 assaults on our brave and professional emergency staff prosecuted? Perhaps the Secretary of State or his ministerial colleague would like to intervene to explain why our staff are assaulted on a daily basis, yet prosecutions do not take place. The right hon. Gentleman said at the start of his speech that he was dedicated to the staff and he praised them, so why are we not protecting them? My hon. Friend raised a very important issue.
My hon. Friend the Member for West Chelmsford and others raised the issue of getting ambulances to A and E departments and then getting the patients from the ambulance into them. That is a crucial issue. Many clinicians at hospitals have said that they sometimes end up looking at the clock rather than treating patients because they are so worried about the four-hour limit. We have proposed to abolish it and we look forward to seeing it go.
The hon. Member for Wyre Forest (Dr. Taylor) has campaigned on these issues for many years and has a vast knowledge to draw on. He spoke about duplication in respect of NHS Direct and other services, which I alluded to earlier. I am not sure whether the hon. Gentleman is aware of it, but his own ambulance trust, which I understand is the Great Western
Mike Penning: I stand corrected. This is fantastic: the Great Western trust is being looked after by the West Midlands trust, because the Great Western could not look after the situation itself; as its results were so poor, Anthony Marsh, the chief executive of the West Midlands trust, has gone across to help it. Let us hope that the situation improves.
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